Therapy Of Bacterial Vaginosis Research Articles

Вагітність на тлі бактеріального вагінозу: сучасні шляхи вирішення проблеми

Pregnancy against the background of bacterial vaginosis is accompanied by a high risk of obstetric and perinatal complications. Therefore, bacterial vaginosis must be treated in pregnant women. Screening and therapy are performed at the beginning of the II or III trimester of pregnancy. The survival of colonies of pathogenic microorganisms in biofilms is significantly increased, so they can remain viable even at high concentrations of antiseptic. The main advantage of using local combined antiseptic agents is the ability to achieve the maximum concentration of the antibiotic exactly in the place of the greatest accumulation of pathogens with the ability to influence biofilms. The objective: was to compare the efficacy and safety of various regimens of therapy with topical combined drugs (Lynda and Meratin Combi) in pregnant women with bacterial vaginosis. Materials and methods. The biocenosis of the vagina was investigated in 351 pregnant women in the II trimester. The diagnosis of bacterial vaginosis was established if the patient had any three of the Amsel criteria. Results. Microbiological screening of the vaginal biocenosis in the II trimester of pregnancy showed that normocenosis among the surveyed was 18.5%; bacterial vaginosis – 31.6%; vulvovaginal candidiasis – 26.5%; aerobic vaginitis – 22.8%, trichomonas vaginitis – 0.6%. Against the background of bacterial vaginosis, the threat of miscarriage, placental dysfunction occurred 6 times more often, anemia and preeclampsia three times more often, gestational pyelonephritis twice more often than in healthy pregnant women. In most patients, the sensitivity of the vaginal microflora to metronidazole and ornidazole is the same, but depends on the dose of the antiseptic, the sensitivity to miconazole was almost twice as high as to nystatin. This confirms the need for a differentiated selection of antiseptics for local therapy of bacterial vaginosis during pregnancy. Conclusion. A more rapid dynamics of the disappearance of the main symptoms of bacterial vaginosis and the normalization of the pH of the vaginal secretion were noted after the use of the drug Limenda. In order to prevent relapse of the disease, it is necessary to carry out the second stage of treatment with probiotics to restore its own lactoflora. Keywords: screening of vaginal biocenosis in the II trimester of pregnancy; complications of pregnancy against the background of bacterial vaginosis; treating bacterial vaginosis during pregnancy; biofilms; sensitivity of the vaginal microflora to antiseptics; topical treatment of bacterial vaginosis; Limenda; Meratin Kombi.

Vaginal discharge syndrome. Problem with many unknowns

The main reason for visiting an obstetrician-gynecologist is the vaginal discharge syndrome (VDS) of infectious etiology. The most common causes of infectious vaginitis wich are identifed by European researchers are bacterial vaginosis (BV), aerobic vaginitis, vulvovaginal candidiasis and mixed infections. Treatment of VDS is a serious problem not only because of the pathogens’s resistance and frequent recurrences, but especially due to the COVID-19 pandemic which can complicate further patient`s examination for determination of infectious agent and the choice of individual approach to etiotropic therapy.Purpose of study: to investigate the structure of causes of pathological vaginal discharge in Ukrainian women, as well as assess the compliance and effectiveness of their treatment.Methods: 472 doctors of women's consultation centres, gynecological hospitals and centers of reproductive medicine from 23 regions of Ukraine were enrolled in multi-center study of vulvovaginal infections management. During the study, which lasted from August to December 2019, were examined 45,295 patients aged 18 to 59 years who complained for pathological vaginal discharge.Results: analysis of the structure of nosologies that caused VDS showed that the examined patients were most often diagnosed with BV (41.1%), colpitis of mixed etiology (26.59%) and vulvovaginal candidiasis (19.22%), trichomoniasis was confirmed in 8.44%. The interviewed gynecologists preferred topical therapy in 95,99% cases of BV and colpitis of mixed etiology. Topical combined medications were prescribed in 85,21% of cases, monoforms – in 14.79%. Among the combined vaginal dosage forms the combination of metronidazole 750 mg /miconazole 200 mg was preferred in 48.81% of cases with clinical efficacy 87.1% in patients with BV and 86,9% in women with mixed infection. Normalization of the vaginal biocenosis was observed in 93.50% of the examined patients. The study demonstrated the safety, good tolerability and compliance of patients to therapy with the combined medications metronidazole 750 mg / miconazole 200 mg in vaginal suppositories.Conclusion: BV, colpitis of mixed etiology and vulvovaginal candidiasis are predominated in structure of main causes of VDS in Ukraine. In the treatment of VDS, priority is given to vaginal forms with the most compliant (89.8%) regimen: once a day for a short period (7 days). The obtained high bacteriological (93.50%) and clinical (86,9%) efficacy of therapy of BV and vaginal mixed infections with the combined drug metronidazole 750 mg / miconazole 200 mg allows to recommend it as the drug of choice.

Entrapping Living Probiotics into Collagen Scaffolds: A New Class of Biomaterials for Antibiotic‐Free Therapy of Bacterial Vaginosis

AbstractA new concept of biomaterials for antibiotic‐free therapy of bacterial vaginosis (BV) is here proposed. These biomaterials are obtained by entrapping two probiotic biofilms, viz., Lactobacillus fermentum (Lf) and Lactobacillus acidophilus (La) into scaffolds of self‐assembled collagen fibers (col). An in‐depth characterization and viability assays are performed on the resulting biomaterials. Results demonstrated that the collagen matrix plays a multifold role in improving the probiotic efficacy in a BV‐simulated environment: i) it acts as a host to the formation of the probiotic biofilm, ii) it protects live probiotics during storage under harsh conditions, iii) it enhances the metabolic activity of entrapped probiotics thereby restoring the pH of BV‐simulated microenvironment, and iv) it enhances the adhesion of probiotics to the simulated vaginal mucosa. These collective properties make these biomaterials as promising candidates for treating BV without antibiotics. In addition, the approach here presented can be adapted for the treatment of other complex microbial infections.

Diagnosis and therapy of mixed and recurrent vulvovaginal infections

Infections of the vulva and vagina remain one of the most pressing problems of modern gynecology due to the high prevalence, frequent relapses, and negative effects on the functions of the reproductive system, which increases the risks of gynecological diseases and obstetric complications. The most common forms of vulvovaginal infection are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic vaginitis (AB) and trichomoniasis. Features of the biocenosis and immune status in infections caused by conditionally pathogenic microorganisms predispose to relapses of BV, AB, and VVK, against the background of which a mixed infection develops. Its occurrence is also the result of repeated courses of treatment for recurrent monoinfection. Therapy of BV consists in the use of metronidazole and clindamycin, the benefits of clindamycin are in a wider spectrum of action, covering difficult to identify anaerobic microorganisms, as well as aerobes. The treatment of mixed infection and the prevention of the development of IHC in patients with BV involves the use of azole antimycotics, which remain the first line treatment option for the infection caused by Candida albicans. Thus, the combination therapy with clindamycin and azole antimycotics can be considered the optimal treatment option for mixed and recurrent vulvovaginal infections.

Therapy of bacterial vaginosis

Aim:evaluation of efficacy of Multi-Gyn® Actigel application in the complex therapy of bacterial vaginosis (BV) and prevention of its recurrence in pregnant women.Patients and methods:87 patients of reproductive age were examined and treated with the diagnosis of «bacterial vaginosis, chronic recurrent course». 41 of them from the main group were given Multi-Gyn® Actigel at the 1st stage of treatment, while 46 women of the comparison group were given 2% clindamycin cream In order to restore vaginal microbiocenosis, a probiotic containing Lactobacillus casei rhamnosus spp. LCR35 was used in both groups at the second stage Clinical laboratory methods were used.Results:efficacy of Multi-Gyn® Actigel application in complex therapy of BV and prevention of its recurrences in non-pregnant women was proved. As a result of Multi-Gyn® Actigel prescription there were no complaints, pH level was normalized, almost complete absence of BV-associated microorganisms was achieved and lactobacillus pool preservation even in the distant period after treatment.Conclusion:Multi-Gyn® Actigel is an effective remedy for treatment of BV and prevention of its recurrence in non-pregnant patients, especially in the chronic recurrent course of the disease. This effect is achieved not only by eliminating anaerobic microorganisms, but also due to the persistent preservation of the lactobacillus pool.

Giving Probiotic for a Better Therapy of Bacterial Vaginosis

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Сучасні підходи до корекції дисбіозу піхви у вагітних після антибактеріальної терапії

The objective: is to evaluate the effectiveness of the use of the Floric probiotic system for the restoration of vaginal microbiocenosis after antibiotic therapy during pregnancy. Materials and methods. We examined 58 pregnant women, in the II and III trimester of gestation, who received antibacterial therapy for bacterial vaginosis, nonspecific vaginitis and cervicitis, trichomonas colpitis and vulvovaginal candidiasis. All pregnant women underwent a general clinical examination, bacterioscopic and bacteriological examination of vaginal secretions immediately after the end of antibiotic therapy, on the 7th and 14th day of observation. All patients received probiotic Florica, which was used vaginally by 1–2 suppositories for 10 days after antibacterial therapy. Results. Bacterioscopic and bacteriological examination of vaginal contents showed that antibacterial therapy leads to excessive growth of conditionally pathogenic flora and depression of symbiotic microorganisms. Lactic acid bacteria in the dynamics of treatment with probiotic Floric were detected in the increasing titer in the majority of the examined. Recovery of vaginal flora after treatment was observed in 56 (96.5%) women. The level of vaginal pH decreased to normal values (pH <4.5) in almost all women included in the examination group (94.8%). Conclusion. Antibacterial agents, regardless of group affiliation, negatively affect the state of vaginal microbiocenosis, contributing to the development of antibacterial vaginal dysbiosis. The use of the Floric probiotic system allows to bring to a qualitatively new effective level the prevention and treatment of dysbiotic disorders in pregnant women, which will certainly improve the perinatal outcomes and ensure the formation of the physiological microbiocenosis in the biotopes of the newborn. Key words: pregnancy, antibiotic therapy, dysbiosis, probiotic Florica.

Present-day trends in treatment of bacterial vaginosis

The most frequent infectious disease of the female reproductive system is bacterial vaginosis (BV). The increased interest in this nosology is explained by the clinical manifestation severity of the disease, rather than numerous data indicating the inextricable connection between BV and inflammatory diseases of female genitourinary system and the complications of pregnancy and delivery. The bacterial biofilm formation, which is found in 90% of cases, have been shown to provide bacteria with protection against antimicrobial agents, representing the specificity of the BV pathogenesis, which militates against the effectiveness of the treatment. The official guidelines recommend to use metronidazole and clindamycin as the first-line therapy for BV in Russia and abroad. However, the present-day concept of BV therapy provides for a comprehensive two-stage treatment with a wide range of combination drugs to eradicate BV-associated microorganisms. Due to the lack of a systemic effect, the preference should be given to combination drugs designed for local therapy. Tergynan is one of the most popular drugs used for topical BV therapy, which demonstrated clinical efficacy and ease of use. Analogue of Tergynan, ornidazole + neomycin + prednisolone + econazole is a topical drug with antibacterial, antifungal and anti-inflammatory components, but has more modern antibacterial (ornidazole) and antifungal (econazole) components. The Russian studies showed convincing efficacy, safety and ease of use of a drug containing ornidazole + neomycin + prednisolone + econazole in BV therapy, which makes it possible to recommend it for practical use.

Принципы терапии бактериального вагиноза, ассоциированного с Gardnerella vaginalis и Atopobium vaginae, у женщин репродуктивного возраста

Принципы терапии бактериального вагиноза, ассоциированного с Gardnerella vaginalis и Atopobium vaginae, у женщин репродуктивного возраста

Опыт терапии бактериального вагиноза

Опыт терапии бактериального вагиноза

Recent Biomarker-Confirmed Unprotected Vaginal Sex, But Not Self-reported Unprotected Sex, Is Associated With Recurrent Bacterial Vaginosis.

Self-reported unprotected vaginal sex seems to increase risk of bacterial vaginosis (BV). However, the validity of self-reports is questionable, given their inconsistency with more objective measures of recent semen exposure such as detection of prostate-specific antigen (PSA). We examined whether recent unprotected sex, as measured both by PSA detection on vaginal swabs and by self-report, was associated with increased BV recurrence. We analyzed randomized trial data from nonpregnant, BV-positive adult women recruited from a sexually transmitted disease clinic. Participants received BV therapy at enrollment and were scheduled to return after 4, 12, and 24 weeks. Bacterial vaginosis (by Nugent score) and PSA were measured at each visit. We used Cox proportional hazards models to examine the association between PSA positivity and recurrent BV. We also evaluated associations between self-reported unprotected sex (ever/never since the last visit and in the last 48 hours, analyzed separately) and recurrent BV. Prostate-specific antigen and BV results were available for 96 women who contributed 226 follow-up visits. Prostate-specific antigen positivity was associated with increased BV recurrence (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.28-4.21). In contrast, we observed no significant increase in BV recurrence among women self-reporting unprotected sex since the last visit (aHR, 1.63; 95% CI, 0.77-3.43) or in the last 48 hours (aHR, 1.28; 95% CI, 0.70-2.36). Estimates from earlier studies linking self-reported unprotected sex and BV may be biased by misclassification. Biomarkers can improve measurement of unprotected sex, a critical exposure variable in sexual health research.

Identification of intrinsically metronidazole-resistant clades of Gardnerella vaginalis

Gardnerella vaginalis is associated with bacterial vaginosis (BV), the most common cause of vaginal discharge. Metronidazole is a front-line therapy for BV, and treatment failure and recurrent disease are common problems. Whole-genome sequencing studies have revealed that G. vaginalis has a population structure that consists of 4 clades: clades 1 and 3 are associated with BV, whereas clades 2 and 4 are not. To determine if metronidazole susceptibility is associated with population structure, we analyzed 87 clinical isolates and found that metronidazole resistance (MIC ≥32μg/mL) was highly associated with clade (P<0.0001), as 14/14 clade 3 isolates (100%) and 22/22 clade 4 isolates (100%) exhibited resistance, compared to only 16/37 clade 1 isolates (35%) and 1/14 clade 2 isolates (7.1%). The identification of intrinsically metronidazole-resistant G. vaginalis clades will facilitate future studies on the relationship between metronidazole resistance and BV treatment failure.

Draft Genome Sequence of a Metronidazole-Susceptible Atopobium vaginae Isolate.

We report the draft genome sequence of a vaginal isolate of Atopobium vaginae vaginae (strain 44061), an organism linked to bacterial vaginosis (BV), the most common gynecological infection in the United States. This species is often highly resistant to metronidazole, which is a front-line therapy for BV. Strain 44061 is a metronidazole-susceptible isolate (MIC, 16 µg/ml), and its genome sequence will be useful for comparative studies to elucidate the molecular basis of metronidazole resistance in this species.

Rapid and Profound Shifts in the Vaginal Microbiota Following Antibiotic Treatment for Bacterial Vaginosis

Bacterial vaginosis (BV) is a common polymicrobial disease associated with numerous negative reproductive health outcomes, including an increased risk of human immunodeficiency virus acquisition. BV is treatable with antibiotics, but relapse is common. A more detailed understanding of bacterial dynamics during antibiotic therapy for BV could identify conditions that favor establishment, maintenance, and eradication of BV-associated bacterial species, thereby improving treatment outcomes. We used mathematical models to analyze daily quantitative measurements of 11 key bacterial species during metronidazole treatment for 15 cases of BV. We identified complete reorganization of vaginal bacterial composition within a day of initiating therapy. Although baseline bacterial levels predicted a longer time to clearance, all anaerobic species were eliminated rapidly within a median of 3 days. However, reemergence of BV-associated species was common following treatment cessation. Gardnerella vaginalis, a facultative anaerobe, was cleared more slowly than anaerobic BV-associated species, and levels of G. vaginalis often rebounded during treatment. We observed gradual Lactobacillus species growth, indicating that untargeted microbes fill the transient vacuum formed during treatment. Under antibiotic pressure, the human microbiome can undergo rapid shifts on a scale of hours. When treatment is stopped, BV-associated bacteria quickly reemerge, suggesting a possible role for intermittent prophylactic treatment.

Experience with 5-nitroimidazoles in the therapy of bacterial vaginosis

Experience with 5-nitroimidazoles in the therapy of bacterial vaginosis

Metronidazole Vaginal Gel 0.75% (Zidoval TM) for Suppresion of Recurrent Bacterial Vaginosis (BV): A Pilot Clinical Trial

Objectives: A pilot efficacy and tolerability trial of suppressive metronidazole vaginal gel in reducing recurrent symptomatic relapses of bacterial vaginosis (BV). Study design: A prospective open labeled study. Women with recurrent BV were assigned to metronidazole gel 3 times monthly for 24 weeks. The mean episodes of relapses of recurrence of BV after metronidazole suppression was compared to historical mean obtained from the same participants by a paired-sample T test. An exit interview was used to record patient satisfaction. Results: The mean symptomatic relapses of BV was 0.44 (SD1.09). Historically, participants had a mean of 6.5 (SD3.09) by clinical or laboratory criteria, and a mean of 3.75 (1.06) by laboratory criteria only. Compared with each of the historical means by paired-sample T test, the difference is significant in both at P<0.0001. Adverse effects were uncommon. Conclusions: Suppressive therapy of BV with metronidazole gel for 3 days after the menstrual cycle resulted in significant reduction in symptomatic relapses. Adverse effects were uncommon. A randomized controlled trial is needed to further validate these results.

Diagnosis and therapy of bacterial vaginosis in pregnancy

Bacterial vaginosis (BV) is the most common vaginal disorder in women of reproductive age. This review presents literature data regarding a role of BV in adverse reproductive health outcomes, describes current methods used for BV diagnosis and issues of treatment of this disease in pregnant women.

Клінічні аспекти терапії бактеріального вагінозу у вагітних

Therapy of bacterial vaginosis (BV) during pregnancy remains a complicated problem due to аn unfavourable influence of etiotropic preparations on the fetus. BV treatment at early stages of pregnancy is the most effective prevention of complications during the period of pregnancy, labor and the postnatal period. That's why, a search for effective and safe preparations for the embryo to treat BV at early stages of pregnancy is a topical task of modern obstetrics.

Pregnancy-specific association of vitamin D deficiency and bacterial vaginosis

Recent data suggest vitamin D deficiency (VDD) is associated with bacterial vaginosis (BV) during pregnancy. We hypothesized that VDD is a risk factor for BV in nonpregnant women. Using National Health and Nutrition Examination Survey data, we conducted multivariable logistic regression analyses stratified by pregnancy. VDD was associated with BV only in pregnant women (adjusted odds ratio [AOR], 2.87; 95% confidence interval [CI], 1.13-7.28). Among nonpregnant women, douching (AOR, 1.72; 95% CI, 1.25-2.37), smoking (AOR, 1.66; 95% CI, 1.23-2.24), and black race (AOR, 2.41; 95% CI, 1.67-3.47) were associated with BV; oral contraceptive use was inversely associated with BV (AOR, 0.60; 95% CI, 0.40-0.90). VDD moderated the association between smoking and BV in nonpregnant women. Risk factors for BV differ by pregnancy status. VDD was a modifiable risk factor for BV among pregnant women; evaluation of vitamin D supplementation for prevention or adjunct therapy of BV in pregnancy is warranted.

The use of Lactobacillus rhamnosus in the therapy of bacterial vaginosis. Evaluation of clinical efficacy in a population of 40 women treated for 24 months

Bacterial vaginosis (BV) is the most prevalent vaginal disorder in adult women worldwide. A number of clinical studies indicate that re-establishment of the physiological ecosystem by re-colonization of vaginal mucosa by lactobacilli may be an effective therapy for BV both after initial antimicrobial therapy or when given alone. A vaginal pH <4.5 is considered physiological and its measurement has been reported as an objective parameter, very sensitive to alterations of vaginal microflora and correlated with clinically relevant BV. The aims of this work were to assess the effectiveness of a long-term (24 months) intravaginal treatment with Lactobacillus rhamnosus (NORMOGIN) on the vaginal pH and on the clinical symptoms in a group of 40 women affected by BV diagnosed by the Amsel criteria. A prospective open clinical trial was performed in 40 consecutive cases evaluated for B.V. by the Amsel criteria. Vaginal pH was above the physiological value of 4.5 in 36 out of 40 patients at the first visit. It returned under 4.5 value in 24/40 and 32/40 women after 12 and 24 months of treatment, respectively. pH values were significantly decreased at 12 month treatment (P < 0.001) and further reduction in pH values was found at 24 months of treatment (P < 0.02 vs. 12 months). The gradual return to a vaginal physiological pH was associated with a reduction of the intensity of symptoms as shown by the decrease in the symptoms score. The present study supports the use of pH measurement for sensitive, objective, and simple therapy follow-up in women with BV and shows that long-term administration of vaginal tablets containing Lactobacillus rhamnosus represents an effective and safe treatment for restoring the physiological vaginal pH and controlling BV symptoms.